The proposed research would continue ongoing studies of fractures in the elderly using Medicare claims and enrollment files. With current funding, the investigators have developed methodologies to manipulate claims in order to identify subjects with fractures of interest and exclude those in whom the fracture is not new, is due to metastatic cancer, or has been coded in error. They have applied these methods to study the incidence and outcomes of fractures of the proximal femur (hip), proximal humerus, and distal forearm, the most common osteoporotic fractures. Since most work on osteoporotic fractures has focused on fracture of the hip, the investigators now propose to study important issues regarding other fractures. These include: (1) geographic and racial differences in the rates of fractures of the distal forearm, proximal humerus, and ankle; (2) the basic age/sex-specific incidence patterns of fractures of the shaft of the humerus, shafts of the radius and ulna, pelvis, shaft of the femur, proximal tibia, shafts of the tibia/fibula, and ankle; and (3) mortality after fractures of the proximal humerus, distal forearm, and ankle. They also plan to investigate the accuracy of the claims coding, the precision of the case-identification algorithms developed with current funding, and the ability of one Medicare carrier to provide rapid notification of fracture cases for epidemiological research. To accomplish these goals, the investigators will develop claims-based algorithms to identify the fractures under study utilizing Medicare's 5% National Sample of claims for the years 1985-1989 as a data base. Population denominators of rates will be developed from the Medicare enrollment files. Mortality, hospitalization, nursing home residence, and other outcomes after the fractures will be ascertained through linkage with the vital status fields of the enrollment file and with the Medicare claims files in the years after the fractures. Blue Cross/Blue Shield of Massachusetts will provide rapid notification of patients with claims indicating fracture of the proximal humerus or distal forearm. These patients will be contacted for permission to obtain medical records and the Medicare codes will be compared with those from a uniform coding performed at Dartmouth.